Full Terms & Conditions of access and use can be found at
https://www.tandfonline.com/action/journalInformation?journalCode=uhmt20
Journal of Human Trafficking
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/uhmt20
The Aftermath of Human Trafficking: Exploring
the Albanian Victims’ Return, Rehabilitation, and
Reintegration Challenges
Klea Ramaj
To cite this article: Klea Ramaj (2021): The Aftermath of Human Trafficking: Exploring the
Albanian Victims’ Return, Rehabilitation, and Reintegration Challenges, Journal of Human
Trafficking, DOI: 10.1080/23322705.2021.1920823
To link to this article:  https://doi.org/10.1080/23322705.2021.1920823
© 2021 The Author(s). Published with
license by Taylor & Francis Group, LLC.
Published online: 07 May 2021.
Submit your article to this journal 
Article views: 2683
View related articles 
View Crossmark data
The Aftermath of Human Trafficking: Exploring the Albanian 
Victims’ Return, Rehabilitation, and Reintegration Challenges
Klea Ramaj
Institute of Criminology, University of Cambridge, Cambridge, UK
ABSTRACT
Since the collapse of communism in the 1990s, Albanian women and chil-
dren have been increasingly trafficked in countries across Europe. While 
extensive literature addresses the organizational structure and the factors 
making human trafficking thrive, the experiences of victims of human traf-
ficking upon their return to their home countries is a commonly under- 
represented concern. This article addresses the present gap in research by 
exploring the rehabilitation and reintegration challenges faced by Albanian 
victims of sex trafficking and forced begging upon their return to Albania, as 
reflected by 15 professionals providing direct assistance to the victims. The 
fieldwork was conducted in three Albanian cities and all four organizations 
responsible for the rehabilitation and reintegration of trafficking victims in 
Albania participated in the study. Data from the interviews with practitioners 
indicate that most victims returned involuntarily to Albania. During the 
rehabilitation and reintegration process, victims encountered numerous 
challenges on individual, familial, social, economic, legal, and institutional 
levels. Findings suggest that following their return to Albania, victims are 
perplexed regarding their self-identity, face health problems, criminal prose-
cutions, familial exclusion, and stigmatization, and lack support in gaining 
economic independence, feeling safe, and accessing justice.
KEYWORDS 
Victims; voluntary and 
involuntary return; 
rehabilitation; reintegration; 
human trafficking; Albania
Short Statement
The promotion of voluntary return of trafficking victims is one of the main long-term strategic goals of 
the Albanian government (Ministria e Brendshme, 2016a). However, for this goal to materialize, two 
steps need to be taken. First, victims would need to be genuinely volunteering their return and second, 
victims would have to be provided with all the necessary means for a successful reintegration. 
Understanding the return and reintegration challenges from the victims’ perspective would not only 
help the Albanian government design better policies, but it would also contribute in ameliorating 
victims’ post-trafficking lives by strengthening their position in the Albanian society and by preventing 
further re-trafficking and re-victimization. Such an aim is also in line with Goal 16 of the UN SDGs, 
namely the promotion of just, peaceful, and inclusive societies. Consistent with the recommendations 
set forth by the Human Trafficking Foundation (2018), voluntary return should be facilitated as safely 
as possible and followed by effective and appropriate reintegration assistance in the country of origin.
Introduction
Human trafficking is an abuse of an individual’s rights and dignity, involving the exploitation of 
vulnerable persons through the use of fraud, force, threat, or deception for the sole purpose of 
CONTACT Klea Ramaj kr451@cam.ac.uk Institute of Criminology, University of Cambridge, Sidgwick Avenue, Cambridge 
CB3 9DA, UK
This article has been republished with minor changes. These changes do not impact the academic content of the article.
JOURNAL OF HUMAN TRAFFICKING                   
https://doi.org/10.1080/23322705.2021.1920823
© 2021 The Author(s). Published with license by Taylor & Francis Group, LLC. 
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http:// 
creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the 
original work is properly cited, and is not altered, transformed, or built upon in any way.
economic gain (Europol, 2016; United Nations [UN], 2000). It is one of the fastest growing areas of 
criminal activity worldwide, with women and children from developing countries being the ones most 
affected (International Labor Organization [ILO], 2017; Kleemans & Smit, 2014; Troshynski, 2011).
Albania is one of the key origin countries for the trafficking of women and children to Western 
Europe (Eurostat, 2015; GRETA, 2016). Despite the pervasiveness of such phenomenon, scholars have 
not dedicated adequate attention to the issue of human trafficking in Albania, with the main data 
regarding the problem being portrayed by international and local institutions’ reports (e.g. 
International Organization for Migration [IOM], 2015; GRETA, 2016; Vatra, 2017; Home Office, 
2018). Within a handful of articles and book chapters published about Albanian human trafficking, the 
focus has predominately been on structured networks (Leman & Janssens, 2006), patterns of recruit-
ment (Gjermeni et al., 2008b), and factors that influenced the increase in trafficking following the 
collapse of communism during the 1990s (Hysi, 2007; Van Hook et al., 2006). To date, no studies have 
investigated the return and reintegration process of trafficking victims to Albania (Ministria 
e Brendshme, 2016b). Not knowing the victims’ challenges undermines efforts to improve their 
situation. Such lack of evidence-based analysis is concerning particularly in light of the U.S. 
Department of State’s (2018) conclusion that the Albanian government does not meet the minimum 
standards for the elimination of trafficking and assistance of victims.
The aim of this article is to address the present gap in research by exploring the challenges of 
Albanian victims of human trafficking upon their return to Albania, as conveyed by practitioners 
providing direct assistance to them. It focuses on victims exploited for sexual purposes and forced 
begging. Even though internal trafficking in Albania has been rising in recent years (Meshi et al., 2009), 
the primary focus of this article is on Albanian victims who have been trafficked internationally. It was 
hypothesized that this group of victims is the most disadvantageous one for two main reasons. First, 
victims trafficked internationally tend to be recruited by powerful criminal networks, which are linked 
to other transnational crimes, including drug trafficking and the corruption of government officials 
(Hodge & Lietz, 2007; Richard, 1999). Contrastingly, victims trafficked internally are usually exploited 
by small groups of unorganized individuals. Second, the researcher wished to capture both the 
experiences of return and reintegration. Crossing international borders and returning from a devel-
oped country to a developing country of origin poses a greater challenge than movement within 
national borders. The theoretical framework guiding this work is based on the victim-centered 
approach. A victim-centered approach to trafficking implies the re-direction of the spotlight of 
attention from the fight of organized crime to the victims’ needs and rights (Antkowiak, 2011; 
Goodey, 2004a, 2008). At present, victim-centered justice policy is commonly adopted without an 
insight into what victims really need and want. As such, Goodey (2004b) proposes that academic 
research should play a greater role than it currently does in reviewing policy developments that are 
purportedly “for” victims and their expressed preferences. Hence, this article portrays the return, 
rehabilitation, and reintegration post-trafficking challenges through the victims’ perspective, both 
experientially and chronologically.
The article starts by reviewing the legal and theoretical literature on the return and reintegration of 
trafficking victims. It then details the methodological steps in implementing this study in three 
different Albanian cities – Tirana, Elbasan, and Vlora. The article then presents the results from 
interviews with service providers. These results are grouped in three main sections: 1) An exploration 
of trafficking victims’ initial challenges upon their return to Albania; 2) An analysis of the victims’ 
socio-economic problems; and 3) An overview of the legal and institutional barriers faced by victims. 
The article draws on the theoretical umbrella of critical victimology, which posits that harm and the 
granting of victimhood is contingent upon the social and structural contexts in which victims are 
embedded (Mawby & Walklate, 1994). In the end, the article draws preliminary conclusions about the 
findings, highlights the limitations, and suggests avenues for future research.
2 K. RAMAJ
Literature Review
Victims of any kind have always generated feelings of compassion, with the more defenseless victims 
being the primary targets of altruistic human sentiments (Fattah, 2016). However, victimization is not 
an objective reality and what a victim experiences almost never matches the legal and social inter-
pretations of victimization (Spencer, 2011; Walklate, 2012). The following sub-sections reflect on the 
contrast between the seemingly victim-centered legal measures and theoretical discussions of return 
and reintegration, and the tangible reality as experienced by victims.
Understanding Return and Reintegration
The Legal and Institutional Framework
In the trafficking context, the term return refers to the process of returning trafficking victims from the 
country in which they were identified to their country of origin (Organization for Security and Co- 
operation in Europe, 2014). On an international legal level, the return process is addressed in Article 8 
of the Palermo Protocol (UN, 2000). This article provides that the return of a trafficking victim should 
be conducted “with due regard for the safety of that person” (Article 8.1) and “shall preferably be 
voluntary” (Article 8.2). Voluntary return involves obtaining the consent of the returnee, confirming 
that the consent is given free of coercion, and ensuring that it is based on accurate information that 
describes potential risks and alternative options to return (IOM, 2012). The reference to “preferably 
voluntary” in the Palermo Protocol is however problematic. Given that the nature and quality of 
destination countries’ obligation is unclear, it is plausible to argue that such a clause is meaningless in 
both practical and legal terms (Gallagher, 2010). Since taking into consideration the voluntariness of 
trafficking victims is not mandatory, transit and destination countries forcibly return victims more 
often than not (Segrave, 2009; United Nations Office on Drugs and Crime [UNODC], 2009). Research 
has shown that forced return to the country of origin has serious consequences for trafficking victims 
(Adams, 2011; Prina, 2003). For example, a recent IOM study found that trafficked persons who had 
been forcibly returned to their countries of origin were more vulnerable to re-trafficking (Jobe, 2010). 
When returning to their countries of origin, victims face the same adverse conditions that contributed 
to their trafficking vulnerabilities (Le, 2017; Paasche et al., 2018).
A critical aspect of safe return is supported reintegration, given that trafficking victims who are 
supported with reintegration assistance are less vulnerable to intimidation and social isolation 
(Gallagher, 2010). Even though the Palermo Protocol does not refer to reintegration, a large number 
of non-binding international guidelines have emerged since 2000 to encourage policy approaches in 
the best interest of the victim (see IOM, 2007; Office of the High Commissioner for Human Rights, 
2002; UNODC, 2006, 2008). Following these guidelines, the services offered to the victims should 
cover basic needs such as shelter, medical, psychological, and legal assistance in the short-term, and 
professional training, job placement, accommodation, and reunification with the family and commu-
nity in the long-term. Nevertheless, victim assistance in the origin country, where the victim is 
returned, is often inadequate (European Commission [EC], 2004). Research has shown that these 
programs are not always sufficiently funded to address the full range of victims’ needs, particularly in 
the long-term (Jobe, 2010; Simeunovic-Patic, 2005).
The Theoretical Level
A persistent finding in research that examines the theoretical dimensions of trafficking victims’ return 
and reintegration is the pervasiveness of a linear trajectory (Segrave et al., 2009). Much of the available 
research notes three phases in the trafficking experience: 1) initial safety in the origin country, 2) 
exploitation in the destination country, and 3) back to safety in the country of domicile (Schloenhardt 
& Loong, 2011). Returning home is thus often parallelized with safety (Sharma, 2003). However, the 
idea of home as a safe place is complicated by the fact that many victims return to similar 
JOURNAL OF HUMAN TRAFFICKING 3
disadvantageous economic, social, and familial situations that pushed them into trafficking in the first 
place (Le, 2017).
Derks (1998) argues that reintegration of a trafficking victim is more than a geographical movement 
back to the origin country. It is rather a phased process of recovery, where the focus is on a “positive 
movement from an undesirable state to a more desirable condition” (Reimer et al., 2007, p. 47). Scholars 
agree that reintegration takes place at different levels: at an individual level, within the trafficked person’s 
family environment, within the wider community, and within the overarching formal society (Pandey et al., 
2013; Surtees, 2010; Surtees et al., 2016). Thus, reintegration consists of a long-term and multi-faceted 
process that is incomplete until the person becomes an active member of the economic, cultural, social, and 
political life of his/her country (Zimmerman, 2007). The term “reintegration” is however not without its 
problems, since it implies that the individual was integrated in society prior to being trafficked. In many 
cases, trafficked persons have never experienced social integration due to economic or social margin-
alization in their countries of origin (Aronowitz, 2015; Surtees, 2008). Studies have found that the problems 
faced by victims prior to being trafficked are inextricably linked to their reintegration challenges (e.g., 
Lyneham, 2014).
Many scholars agree that reintegration programs offered by NGOs in the form of psycholo-
gical, legal, economic, or medical assistance are important in helping victims reintegrate in their 
communities (e.g., McCarthy, 2018; Surtees, 2017). Nevertheless, Bearup (2016) maintains that 
the notion of reintegration as a provision of formal assistance is a form of narrow prescription. 
According to him, such procedural delivery of assistance leaves little room for focusing on the 
role of informal networks and “the socio-cultural processes implicated in the substantive 
achievement of reintegration and the rebuilding of relationships” (p. 168). Moreover, Bearup 
(2016) claims that the prevalence of assisted protection may increase dependency and minimize 
the agency of the victim being reintegrated. This notion is also implicitly supported by Surtees 
(2006), who posits that the victims’ empowerment, independence, and self-sufficiency are central 
aspects of a successful reintegration.
To reiterate, a plethora of legal frameworks and theories suggest various conceptualizations of 
the terms “return” and “reintegration”. Nevertheless, the existent literature has placed less 
importance on how returned victims themselves experience their post-trafficking lives (Lisborg 
& Plambech, 2009; Surtees, 2007). This research gap is also explicitly acknowledged by the 
Albanian Ministry of the Interior: “Currently, there are no comprehensive studies – either 
qualitative or quantitative – on the return and reintegration of trafficking victims in Albania” 
(Ministria e Brendshme, 2016b, p. 13).
Methodology
Albanian Anti-Trafficking Shelters and Access
There are four institutions offering rehabilitation and reintegration services to trafficking victims in 
Albania. Three are NGOs: Different and Equal (D & E) in Tirana, Vatra Psycho-Social Center in Vlora, 
and Another Vision in Elbasan. The fourth is the National Reception Center for Trafficking Victims 
(NRCTV) in Tirana (Gjermeni et al., 2008a; GRETA, 2016). All four institutions agreed to participate 
in the research. Fieldwork was carried out in May 2019 and lasted three weeks.
Sample Selection
The initial plan was to conduct 20 interviews, 10 with service-providers and 10 with victims who had 
been trafficked outside Albania. However, studies on human trafficking involve several methodologi-
cal challenges and there are certain limitations to what is possible (Brunovskis & Surtees, 2013; Cwikel 
& Hoban, 2005). In the present case, it was not possible to interview victims due to their fear of being 
4 K. RAMAJ
stigmatized. Such sentiment is also supported by Siegel and De Wildt (2015), who argue that 
interviewing trafficking victims is impeded by their “urge for self-preservation” (p. 11).1
Hence, another approach was taken and the target number of interviews with practitioners was 
increased.2 As noted by Baker and Edwards (2012), the answer to “how many participants are enough” 
is influenced by numerous outside determinants. In this case, the external limitation was the sampling 
frame (Bachman & Schutt, 2017). The scale of the system handling the reintegration of trafficking 
victims in Albania is small, with the number of professionals working in each organization ranging 
from 9 to 15. Purposive sampling was used to select a total of 15 professionals – who had worked 
directly with trafficking victims – from all four organizations.
The main criterion was to interview at least three different professionals from each organization in 
order to capture the multi-faceted challenges faced by the victims. The distribution of interviews 
between different professional categories was as follows: social workers (7), psychologists (5), lawyers 
(2), and medical doctor (1). The experience that each interviewee had in offering direct assistance to 
trafficking victims ranged from one year and a half to seventeen years (see Table 1). The final sample 
represented all the actors who were directly involved in the rehabilitation and reintegration process of 
trafficking victims in Albania. For example, all the psychologists of all four institutions were included 
in the study and in two cases the sole lawyer of the organization was interviewed.
Data Collection
Data collection was carried out via semi-structured interviews. This approach allowed for some 
consistency in the number of themes to be covered, whilst at the same time leaving room for successive 
questions to follow up on the interviewee’s responses (Maxfield & Babbie, 2018). The interviews took 
place in designated offices and lasted from 40 to 65 minutes. All interviews were conducted in 
Albanian and transcribed in whole within five days of having been conducted.
Even though the integration of the victims’ voice was not possible, understanding the victims’ 
challenges through the interviews with professionals was beneficial in three main ways. First, practi-
tioners had gained the victims’ trust, knew their stories in detail, and had seen the victims’ challenges 
Table 1. Background data on practitioners.
ID Profession/Current position Years of work experience with victims of human trafficking
SW1 Social worker with a coordinating role 2 years
SW2 Social worker with a coordinating role 17 years
SW3 Social worker/project manager 14 years
SW4 Social worker/project manager 17 years
SW5 Social worker 3 years
SW6 Social worker 4 years
SW7 Social worker with a coordinating role 4 years
PSY1 Psychologist 2 years and a half
PSY2 Psychologist 10 years
PSY3 Psychologist 3 years and 3 months
PSY4 Psychologist with a directing role 3 years and a half
PSY5 Psychologist 3 years
LAW1 Lawyer 1 year and a half
LAW2 Lawyer 5 years
MED General medical practitioner 3 years
1Victims often self-censor because of fear of reprisal from their trafficker, their stage in the recovery process, and concerns that their 
community members might stigmatize them (Brennan, 2005). Given that Albania tends to be a collectivist, tight-knit, and 
patriarchal society, my “insider” status of being Albanian (see Merton, 1972) might have propelled victims into believing that 
I would judge them or that I would share their stories with other potential known members of the community. Social workers also 
pointed out that most victims had lost faith in others, particularly after being stigmatized by several members of the Albanian 
society (e.g., neighbors, family members, policemen, medical doctors, landlords, employers etc.)
2I have complemented the findings from interviewing practitioners with juridical cases in the literature.
JOURNAL OF HUMAN TRAFFICKING 5
following their return to Albania first-hand. Second, professionals were aware of the victims’ chal-
lenges throughout all the return and reintegration phases: from the moment the victims sought help in 
the destination countries, to the moment they left the organizations and began an independent life. 
Third, interviewing experts proved to be an effective means of quickly obtaining results (also see 
Bogner et al., 2009). Service providers had observed many cases across several years, had shared 
information among themselves, and could draw parallelisms and differences. They could thus provide 
reflections and multifaceted analytical lenses that individual victims might not provide.
Ethics
Prior to starting the fieldwork, ethical approval was obtained from the Institute of Criminology, 
University of Cambridge and the Albanian State Social Services. To ensure that participation was 
voluntary, all participants were given information sheets and consent forms in Albanian before being 
interviewed. These documents outlined the purpose of the research, explained the participants' right to 
withdraw from the study at any time, and offered explanations of how their personal data would be 
used. If interviewees had further questions, they were provided with verbal clarification. Only IDs were 
used when quoting the professionals, to protect their confidentiality and anonymity.
Data Analysis
The final data analysis followed the principles of inductive thematic analysis techniques and was 
carried out in three main steps (see Boyatzis, 1998; Braun & Clarke, 2006). First, the transcripts were 
read several times to get a sense of the whole. Second, transcript texts were divided into codes that 
signified a single issue or idea (Grbich, 1998). Third, codes were compared and contrasted against each 
other and similar codes were placed into themes (Rapley, 2011). As noted by Van Nes et al. (2010), 
researchers should stay as much as possible in the original language during the data analysis process to 
avoid loss of meaning. Hence, both transcription and subsequent thematic analysis were carried out in 
Albanian. Unless otherwise specified, the challenges discussed throughout the following sections are 
experienced by both victims trafficked for sexual purposes and forced begging.
Results
Returning Home
Statistical data on returned Albanian trafficking victims are not available. Evidence from the interviews 
revealed that most assisted returned victims were females who had been trafficked for sexual purposes 
(either through forced prostitution or sham marriages) and children who had been trafficked for 
forced begging. Destination countries where victims returned from included neighboring countries 
(e.g., Greece, Italy, Kosovo, Macedonia, Montenegro, Serbia) and Western European countries (e.g., 
Germany, France, the UK, the Netherlands, Belgium, Switzerland).
Interviewees reported that the length of the exploitation period varied from six months to seven 
years. Victims were mainly identified through investigations from the police of the destination 
countries. Cases where victims sought active help were rare. In these cases, the help was sought 
from clients, passersby, or social media. The interviewees generally posited that victims trafficked 
outside Albania faced more difficulties in seeking help, mainly because these victims were unfamiliar 
with the language, culture, and institutions of the destination countries. This section examines the 
Albanian victims’ decision to return to their origin country following identification as well as their 
initial experiences and challenges after the return.
6 K. RAMAJ
The Destination versus the Origin Country
Voluntariness in Returning. Consistent with what Gallagher (2010) claims, the interviews confirmed 
the notion that Article 8.2 of the Palermo Protocol, which demands signatory parties to return 
identified trafficking victims “preferably voluntarily”, has little significance in practical terms. As 
one practitioner posits: “From a de jure aspect, the victims’ return is supposed to be voluntary. 
However, most of them usually return to Albania immediately following identification” (PSY4). 
Eleven out of fifteen interviewees claimed that victims do not wish to return to Albania following 
identification in destination countries: “Based on what the victims tell us, they return because foreign 
countries force them to. The majority want to start a new life there” (LAW1). Most practitioners 
indicated that forced return had negative consequences on the victims’ psycho-emotional wellbeing: 
“Returning back to Albania . . . this transition process . . . is very traumatic for the victims. The 
unwillingness of such return makes them particularly prone to stress and anxiety” (SW1).
The reasons that prevented victims from wanting to return were mainly tied to their life in Albania 
before trafficking: “Simply the thought of returning back to Albania is fearful for the victims because 
they know they will be returned to the same adverse conditions that propelled them into trafficking in 
the first place” (SW4). Similar to what the literature suggests (e.g. Aronowitz, 2015; Surtees, 2008), all 
the interviewees claimed that victims had been in a vulnerable position before falling prey to 
trafficking. They came from dysfunctional families and had suffered from severe socio-economic 
problems prior to leaving Albania. Thus, contrary to the linear narrative (Segrave et al., 2009), most 
victims considered Albania to be an unsafe environment, despite it being their country of origin. As 
one social worker notes: “A colleague in England has told me that Albanian victims refuse to 
collaborate during the return process. They say: ‘in Albania my father raped me, my brother beat 
me . . . I don’t want to go back, I am better off here’” (SW2). Such remarks raise doubts as to whether 
destination countries follow Article 8.1 of the Palermo Protocol to ensure the victims’ safety before 
deciding to return them.
Is Return the Best Option?. The professionals had contrasting views with regards to where the 
reintegration process would be more successful for the victims – in the destination or in the origin 
country. Seven interviewees believed that reintegration in the destination country was more beneficial 
for the victims, mainly because of the limited economic opportunities that Albania has to offer. As 
PSY2 reports: “They want financial stability at the end of the day, which is logically more likely to be 
attained in developed countries”. In addition, some professionals suggested that being in a foreign 
country would also protect victims from the stigma they would face in Albania: “Victims that can start 
the reintegration process in destination countries have a higher success rate. Since no one knows them, 
they face less discrimination” (SW3). Interviewees also highlighted the fact that victims would be 
legally safer in destination countries given that “Western countries invest more in the security of their 
citizens” (LAW1).
However, six interviewees argued that the benefits of reintegrating in destination countries came 
with the cost of social ostracism. “No matter what another country can offer to these victims, their self- 
image – which has been severely destroyed – can never be re-built unless they have a sense of identity, 
a sense of belonging, and a social support system” (SW2). Moreover, some interviewees suggested that 
returning to Albania would also allow trafficking victims to heal by confronting their traumas: 
“Coming back and facing early traumas would give victims the strength to move forward. They 
need to reconcile feelings of guilt, shame, and anger, which began to develop before they left Albania” 
(PSY3). Previous research has primarily focused on the disadvantages of returning victims back to 
their home countries, including the chance that they will face a lack of acceptance from the community 
(Ruhi, 2003), a lack of economic opportunities (Ray, 2006), and a lack of family support (Brunovskis & 
Surtees, 2013). The socio-cultural and psycho-emotional advantages of reintegrating trafficking 
victims in their origin countries have been largely disregarded.
JOURNAL OF HUMAN TRAFFICKING 7
Accepting the Victim Status
Following return, whether this being voluntary or involuntary, victims’ first challenge related to issues 
regarding self-image and self-identity. A consistent finding that emerged from the interviews was 
victims’ reluctance to acknowledge their exploitation. Human beings’ motivation to avoid unpleasant 
thoughts or feelings is a widely acknowledged phenomenon (Hayes et al., 1996). Given the traffickers’ 
use of threats, violence, and manipulation, victims had developed denial-like defense mechanisms as 
a means of reducing the pain of physical and psychological abuse: “All trafficking victims experience 
emotional numbness at the beginning. They normalize or deny the abuse they have experienced. They 
have built these protective walls, which help them foster self-preservation” (PSY3). The victims’ 
hesitation to admit their abuse might be caused by several reasons, including loyalty to the trafficker, 
fear of retaliation, shame of being exploited, or a need to distance themselves from their past 
(Aronowitz, 2009; Clawson & Dutch, 2008; Warren, 2012). Refusing to be labeled a victim can also 
be perceived as an empowering act – it gives the sense of control back to formerly abused individuals 
and allows them to have agency over their perceptions of self and their past experiences. Victim labels 
may connote the image of someone being passively abused and in some cases can actively create 
stigma and shame (Williamson & Serna, 2018). Nevertheless, findings from this study suggest that 
denying the trafficking experience had negative implications for the victims, both on a legal and 
psychological level.
Victims are returned to Albania by the destination countries’ relevant authorities. Due to matters 
related to human trafficking investigations, victim identification needs to be further confirmed by the 
Albanian border police:
The first state representatives the victim faces upon arriving in Albania are the anti-trafficking policemen – either 
at the airport or at the coastal border. They are aware of the occurrence of trafficking and their job is to receive the 
victim’s police statement (LAW2).
Nevertheless, most victims gave false testimonies during the interrogation by the Albanian border 
policemen: “Many victims provide false confessions and claim that they have not been trafficked or 
exploited. They also refuse to name the individuals who have accompanied them outside the 
country” (LAW2). There might be several reasons behind the victims’ reluctance to truthfully 
confess to Albanian police. While practitioners mentioned the psychological resistances to the 
traumatic past, threats from the trafficker, or fear of retaliation, another factor that might have 
pushed victims into falsely confessing might be related to a lack of trust toward Albanian authorities, 
due to the latter’s potential stigmatizing comments or involvement in corruptive affairs. The U.S. 
Department of State (2020) points to instances of Albanian government employees complicit in 
trafficking cases. Moreover, Friesendorf (2009) enlists several cases of corrupt Albanian officials 
involved in trafficking. For example, in 2006, five state officers were arrested for various crimes 
relating to their involvement in trafficking, while in 2007, 12 police officers were charged with 
involvement in trafficking. In the Belgian Federal Prosecution Service’s Albanian case LG, one of the 
defendants was an officer in President Berisha’s republican guard and a former agent of Albanian 
security services.
False testimonies are however considered a violation of Albanian criminal laws. Article 305/b of the 
Albanian Criminal Code (2017) states that giving false information to police officers during an 
interrogation is a criminal act punishable by imprisonment up to six months. Article 307 further 
provides that refusing to answer questions concerning knowledge of a criminal offense or its perpe-
trators constitutes a criminal contravention and is punishable by up to one year of imprisonment. 
Even though the EC (2004) suggests that trafficking victims have the right to protection despite their 
willingness to testify and that their penalization should be avoided at any cost, evidence from the 
current study shows that Albanian victims were prosecuted for their reluctance to cooperate with 
authorities: “We have had many cases where victims have been unfortunately convicted for having 
given false testimonies or for refusing to provide information about the traffickers” (LAW2). The 
prosecution of trafficking victims in their origin country due to the provision of false testimonies is 
8 K. RAMAJ
a rather innovative finding. Studies on the criminalization of victims of human trafficking have been 
mainly focused on illegal entry (Goodey, 2003), possession of false documentation (Hales & 
Gelsthorpe, 2012), prosecution under prostitution-related charges (Gonzalez, 2002), and offenses 
related to criminal acts committed under force (Malloch, 2016).
The victims’ resistance to accepting their abuse impacted them on a legal, as well as on 
a psychological level. Data from the interviews suggests that refusing to confront the past pushed 
both victims trafficked for sexual purposes and forced begging into withdrawal. Behavior regulation 
strategies that involve thought and emotion suppression, avoidance, and denial-like mechanisms are 
however counterproductive in emotional management (Gross, 1998; Wenzlaff & Wegner, 2000). 
Moreover, such mechanisms negatively impacted the outcome of therapy:
Acknowledging their traumatic experiences and the fact that their emotional world has been shattered, to me, is 
the first big step towards recovery. Otherwise, therapy is ineffective. It is like ‘tilting at windmills’3 - you cannot 
help someone who doesn’t believe they have a problem (PSY3).
For sex trafficking victims, refusing to accept their past was also problematic in the light of examina-
tions for sexually transmitted diseases (STDs): “When sex trafficking victims enter our organization, as 
a general practice, they need to undergo certain tests to determine whether they have caught STDs. 
However, some victims deny their sexual exploitation, thus making the medical examinations some-
times impossible” (MD). In the opinion of the professionals, overcoming emotional protective walls is 
a lengthy process, which requires the victims’ readiness to collaborate and progress.
Victims’ Rehabilitation
After having established trust in their relationships with the staff, victims would finally start to share 
their story and detailed experiences at the fourth or fifth psycho-social therapeutic session (SW5). At 
this point, the practitioners noticed the scars that trafficking had left on the victims’ mental health: 
“You are in front of a person who has lost faith in others, who has lost the will to live, who has lost self- 
respect. Before reintegrating back into society, victims should first recover from their traumas” (SW2). 
While the literature refers mainly to return and reintegration as distinct phases following victims’ 
post-trafficking experiences, more than half of the interviewees claimed that there was another stage 
between the two: rehabilitation. “The first phase following the return is actually the rehabilitation one. 
Reintegration takes place afterward” (PSY4). The rehabilitation process was carried out within the 
shelter. Its main aim was to strengthen the victims’ psycho-emotional and physical state. 
Rehabilitation is what Surtees et al. (2016) would refer to as “reintegration on an individual and 
personal level” (p. 30).
All participants claimed that victims suffered from a host of health complications, with most of 
these complications being a direct consequence of trafficking. Practitioners indicated that the victims’ 
post-trafficking psychological problems included emotional turmoil, mood fluctuations, depression, 
troubles sleeping, fear, and anxiety. In addition to the psychological consequences of exploitation, sex 
trafficking victims also suffered from infectious diseases: “We have had cases of sex trafficking victims 
diagnosed with syphilis, hepatitis B, and C. They face many difficulties in accepting the diagnosis . . . 
some do not even want to know the outcome of the clinical examinations” (MD). Additional 
individual challenges were related to shame, low self-esteem, and a lack of resilience: “Many victims 
de-value themselves, they think they are unworthy, and perceive every challenge as a personal handi-
cap. They often say: ‘These things happen to me because I am incapable, I am nothing, I deserve to 
suffer’” (PSY2). These results echo previous research on physical and mental health conditions of 
trafficking victims (e.g., Goldenberg, 2015; Kiss et al., 2015; Oram et al., 2012).
3‘Tilting at windmills’ is an idiom which means ‘attacking imaginary enemies’, originating from Miguel de Cervantes’ novel Don 
Quixote. In the present context, the psychologist used this idiom to portray the inefficient efforts of treating traumas, which most 
victims denied having experienced.
JOURNAL OF HUMAN TRAFFICKING 9
While low self-esteem has been identified as one of the main consequences of exploitation (Adam, 
1978; Derks, 1998), the interviews revealed that low levels of confidence had been established since the 
victims’ early childhood. Most victims had experienced physical, emotional, psychological, and/or 
sexual violence by their parents or relatives while growing up in Albania. As one social worker notes: “I 
remember one victim telling me: ‘I have never heard a single positive or encouraging word from my 
parents. They only told me – shut up, you can’t move, you can’t go out, you can’t go to school’” (SW2). 
Research has shown that early exposure to violence interferes with neurological and emotional 
development and is associated with further victimization (Moffitt, 2013; Till-tentschert, 2017). 
These findings were also supported by all the psychologists interviewed in the present study, who 
argued that victims’ dysfunctional thought patterns – which were wired at an early age – were partially 
responsible for their continued victimization: “Early internalized false beliefs about the self are often 
unmalleable and deeply ingrained in their brains . . . these thoughts tend to pull victims back to 
exploitative situations. They continue to feel victimized and are often re-trafficked” (PSY2).
Rehabilitation is commonly defined as restoration to a former state (Pandey et al., 2013). However, 
in the present case, the former state was undesirable. Hence, similar to what Zimmerman (2007) 
argues, most interviewees indicated that starting a new life was a long journey for the victims. This 
journey was particularly challenging for children trafficked for forced begging, since they had suffered 
from severe neglect: “Since these children grew up on the streets, they lack basic life skills. We first 
have to teach them how to eat healthily, how to use cutlery, how to take a shower, how to dress, how to 
behave” (PSY5). Due to the victims’ numerous individual needs, practitioners claimed that the amount 
of time victims spent inside a shelter was insufficient: “One cannot recover from all the traumas in 
their life in solely six months or one year of assistance. Completing the first phase of the program does 
not lead to immediate empowerment for the victims” (SW4). While rehabilitation was deemed time- 
consuming, more than half of interviewees claimed that victims tend to develop institutional depen-
dency if subjected to continuous protection: “If victims stay for lengthy periods of time inside a shelter, 
they become dependent on staff members. Such dependency can be harmful for the victims as it 
negatively impacts their capacity for self-sufficiency” (SW5). This remark is in line with Bearup’s 
(2016) observation that assisted protection can often lead to a minimization of trafficking victims’ 
agency. As such, the community and informal networks have a pressing role during the reintegration 
stage, following the victims’ release from the shelters.
Challenges to Reintegration I: Socio-economic Factors
These victims feel so empty that solely the assistance offered by organizations is insufficient to fill the void in their 
hearts. It takes a lot of work not only from NGO staff, but also from the family, from the community, from the 
state . . . everyone must come together to heal the scars that trafficking has left in these victims’ lives (PSY5).
As also observed by Bearup (2016), a common view among interviewees was that reintegration should 
not be undertaken solely by NGOs and that the formalized assistance offered by trafficking organiza-
tions cannot replace the role of social processes in the attainment of reintegration. All professionals 
interviewed in this study claimed that the reintegration process began when victims left the shelter and 
started to live an independent life in the community. Such sentiment is also in agreement with Derks’s 
(1998) definition of reintegration as “a renewed reunion or incorporation within a social unity” (p. 13). 
Data from the interviews suggest that the greatest difficulties for trafficking victims were encountered 
during the reintegration phase.
For victims trafficked internationally for numerous years, reintegrating back in the Albanian society 
was particularly challenging. Undergoing a re-update and a re-adjustment with the Albanian social, 
cultural, economic, and institutional context took a lot of their psycho-emotional energy. Such 
additional challenges further influenced the length and quality of their reintegration. Moreover, 
after leaving the shelter, victims had to face the same socio-economic challenges that pushed them 
into trafficking in the first instance. In accordance with previous research (e.g., Le, 2017; Lisborg & 
10 K. RAMAJ
Plambech, 2009), most interviewees suggested that reintegration challenges were tied to the victims’ 
life before trafficking, which was mainly characterized by poor economic conditions and parental 
negligence. This section examines the victims’ challenges in reentering the familial and communal 
environment as well as in leading a financially independent life.
Family
Family has always been a strong social structure in Albania. This was particularly evident following the 
collapse of communism in the 1990s. Due to high unemployment, widespread poverty, and weak state 
structures, family became the main and often the only source of security (Nixon, 2009). Familial ties 
are commonly used to establish reputation and trust, secure jobs, navigate through bureaucracy, and 
access justice or political power. The importance of family support in attaining a successful reintegra-
tion following the victims’ release from shelters was emphasized at least three times in every interview: 
“Family is really important, and I will bring it up in every sentence that includes the word ‘reintegra-
tion’” (PSY3). All interviewees noted that supportive families were key in most successful cases of 
reintegration. A common view among practitioners was that apart from being a psycho-emotional 
support system, families can also help victims strengthen economically by accommodating them, 
raising their children, or meeting their financial needs until they found a stable job. Nevertheless, 
reunification with the family was often prevented by early conflictual relationships that had begun 
before victims were trafficked and/or by the family’s reluctance to accept the victims once returned.
Twelve out of 15 practitioners claimed that most families rejected trafficking victims following their 
return to Albania. Such rejection was mainly prevalent among the families of victims trafficked for 
sexual purposes:
In ten years of experience working directly with sex trafficking victims, I can say that exclusion from the family is 
the standard. Parents often say things like: ‘To me she is dead, I do not care whether she lives or not’ (PSY2).
Traditional Albanian families have a patriarchal structure and are characterized by a commitment to 
“shame and honor” as regulators of interpersonal relationships. Cultural norms promoted by the 
Kanun of Lek Dukagjini4 posit that the prevention of collective shame is an important issue for 
Albanian families (Amnesty International, 2006; Arsovska, 2015). While “honor” is a quality asso-
ciated with men, “shame” is a female attribute. The source of familial shame is commonly tied to 
women’s sexual behavior and their unwillingness to submit to patriarchal power (Danermark et al., 
1989). Kanun customary laws place great importance on the submissive role of women in the Albanian 
society, as well as on the masculinity of men (Arsovska, 2006a). Kanun stipulates that a woman is 
a sack made to endure and that her husband has the right to publicly humiliate – or even kill – her in 
case of disobedience (Arsovska & Craig, 2006b). Interviews with practitioners revealed that the 
protection of family honor in the eyes of the community was one of the main reasons for parents’ 
rejection of their daughter: “Parents often claim that reconciliation with their daughter is met by 
rejection from relatives and neighbors. So, most parents choose to reject their daughter 
instead” (SW3).
Although all interviewees stressed the importance of family reunification, they also agreed that 
returning to the familial environment prevented the achievement of a successful reintegration in some 
cases, particularly when family members were involved in the trafficking ring. Such phenomenon was 
more prevalent among Romani and Egyptian children, whose parents had subjected them to forced 
begging in neighboring countries. Members of these two social groups are highly marginalized in 
Albania: they face discrimination, high levels of illiteracy, unemployment, and poor housing conditions, 
with many being homeless or living in self-made shelters (De Soto et al., 2005). Romani and Egyptian 
parents tend to resort to child trafficking when they have no other means of survival (Delap, 2009; 
4The Kanun of Lek Dukagjini codifies the rules on which traditional Albanian culture is based, primarily focusing on the concepts of 
honor, shame, and hospitality (Arsovska, 2015). The original Kanun includes specific clarifications concerning the accepted manner 
of retaliatory killings, for restoring honor to the offended when the laws are disobeyed. Today, for ordinary Albanians, the Kanun 
statement “blood must be taken” still has great significance (Arsovska, 2015, p. 170).
JOURNAL OF HUMAN TRAFFICKING 11
Gjermeni et al., 2008b; Organization for Security and Co-operation in Europe, 2003). Interviewees 
claimed that when children reached the age of 18 and had to leave the shelter, reintegrating alongside 
their families was not a vital option. Since their families’ adverse economic conditions remained the 
same, the probability of re-trafficking was high: “If all the victim’s family members continue to rely on 
begging to make a living, it is very likely that the child will re-start begging as well . . . this does not leave 
much room for a healthy reintegration” (SW6). Apart from poor economic conditions, reintegrating 
within the familial environment was disadvantageous for these children due to parental neglect: “There 
have been instances when children as young as ten years old have gone home for one or two days and 
when they have returned in the shelter, we have noticed that they had consumed alcohol, drugs, or 
cigarettes” (PSY5). Academic research on forced child begging within Romani and Egyptian families in 
Eastern Europe is lacking. Preliminary findings from the current study raise concerns about the 
consequences of such phenomenon and warrant further investigation.
Social stigma 
Social stigma is defined as “the negative regard, inferior status, and relative powerlessness that society 
collectively accords to people who possess a particular characteristic or belong to a particular group or 
category” (Herek, 2009, p. 441). According to Goffman (1963), stigma is a process by which the rejection 
and reaction of others spoils normal identity. Thirteen practitioners stated that trafficking victims were 
stigmatized in all the areas of their lives: “Stigma is everywhere: at school, at work, at professional training 
courses . . . the moment people find out about the victims’ past, they become judgmental” (SW3). Such 
prejudice was more prevalent among victims who had been sexually exploited: “people judge them 
because they think that sex trafficking is equal to willful prostitution” (SW4). The conflation of sex 
trafficking with the exercise of voluntary prostitution is not unfounded and has been previously 
empirically investigated (Agustín, 2005; Butcher, 2003). What has received little attention is the impact 
that such generalizations can have on returned sex trafficking victims, particularly in patriarchal societies 
like Albania, where women’s sexuality is suppressed and condemned.
Most interviewees stated that their organizations took all the appropriate measures not to reveal the 
victims’ pasts. The victims themselves were additionally vigilant about sharing their story with others: 
“Victims are always conscious about their surroundings and try very hard not to share their trafficking 
experience” (SW1). Even though concealing one’s stigmatized status can offer protection from discri-
mination, research has demonstrated that stigma concealment is stressful since it produces cognitive 
burden resulting from fear of discovery (Frost, 2011). Despite efforts taken to preserve the victims’ 
anonymity, 10 interviewees claimed that trafficking victims’ stories were frequently disclosed mainly 
because of the high level of social cohesion in Albania, which allows for the information to spread 
quickly. While stigmatization from neighbors, colleagues, or friends at school impacted the reintegration 
process only on a psycho-social level, discrimination by individuals in a position of power had 
detrimental consequences on victims’ security and economic well-being.
Six practitioners claimed that sex trafficking victims faced rejection in the job market due to 
discrimination: “In many cases, employers have refused to recruit victims after finding out about their 
sex trafficking experiences” (PSY4). Furthermore, five interviewees pointed out that discrimination 
against victims was also pronounced among law-enforcement agents, who instead of offering victims 
protection, exacerbated the prejudicial treatment: “Even in my presence, policemen have said denigrating 
things about sex trafficking victims, such as: ‘Look at what she’s wearing, doesn’t she look like 
a prostitute? She obviously chose to engage in that profession herself’” (LAW1). Some practitioners 
suggested that stigmatization was additionally perpetuated by property owners, who often refused to rent 
out apartments to female sex trafficking victims belonging to ethnic minorities:
When the apartment’s owner discovered that our beneficiary was Romani, he called me and said: ‘Come and get this 
woman out of my apartment. I didn’t know she was a “jevg”5’. The victim is now still living in our shelter (SW5).
5“Jevg” is a pejorative term in Albanian, used against members of Roma and Egyptian communities.
12 K. RAMAJ
Interestingly, stigmatization against Romani and Egyptian children who had been trafficked for forced 
begging was not directed toward their ethnicity or trafficking experience. In such cases, social stigma 
was rather a result of children not meeting the criteria for an ‘ideal victim’6: “Since these children have 
lived all their lives in the streets, they often use vulgar language, are loud, and engage in inappropriate 
behavior. Such conduct is often met by condemnation and rejection from the community” (PSY5).
Thus, even though Albanian trafficking victims might have the will to build a new life and cut ties 
with the past, their reintegration is precluded by the wider social context they are embedded in. From 
a critical victimological perspective (see Spencer & Walklate, 2016), Albanian society can be under-
stood as partially responsible for trafficking victims’ continued victimization.
Economic Challenges
All practitioners claimed that economic difficulties were the biggest challenge experienced by Albanian 
trafficking victims following their release from the shelter: “If your stomach is empty, post-trauma is 
the last thing you worry about – you first need to survive” (PSY3). Securing employment was impeded 
by Albania’s adverse economic situation and scarce job opportunities as much as by the victims’ lack of 
professional qualifications. The interviewees maintained that most victims had interrupted education 
before entering high school and lacked a professional background. Research has shown that job skills 
are important for a trafficking victim to secure financial independence (Macy & Johns, 2011). To 
prepare victims for the job market, all four organizations offered professional training courses as part 
of the reintegration services. Vocational training helped victims develop skills in cooking, tailoring, 
babysitting, hairdressing, or coffee machine repairing. Nevertheless, the income generated in these 
sectors is equal to Albania’s minimum wage, which, as argued by most interviewees, is insufficient to 
cover basic living costs without external support. Ergo, the economic situation for trafficking victims 
not accommodated or financially supported by their families after leaving the shelter was particularly 
challenging. Five practitioners stated that internationally trafficked victims experienced the poverty in 
Albania more negatively than internally trafficked victims. Victims in the former category had been 
exposed to a higher standard of living and could discern the wage disparity between Albania and more 
developed destination countries: “It is the stress of realizing that your life is miserable. When you are 
aware that you live in misery . . . that is when you start feeling desperate. Victims trafficked internally 
don’t know better – for them €200 per month is enough” (PSY2).
Besides limited financial resources and pragmatic obstacles, long-term reintegration was negatively 
influenced by a lack of economic sustainability and exploitative working conditions. Most practi-
tioners stipulated that for trafficking victims, building a healthy lifestyle was highly associated with 
financial steadiness. Nevertheless, employment was often unstable due to factors related to the 
employers’ unwillingness to support victims’ professional development or to the sporadic nature of 
the private businesses in which victims would find employment. According to the interviewees, 
trafficking victims were mainly employed as manual workers in sweatshops with poor working 
conditions: “Victims work unreasonable hours for a low wage and often have no rights to paid 
holidays. In some cases, victims were fired because they had to skip a day from work due to illness” 
(SW2). Such adverse working conditions coupled with the victims’ trauma and existent low self- 
esteem further discouraged and demotivated them. Therefore, the victims’ experiences in the Albanian 
job market can be considered as a form of secondary victimization (see Wolhuter et al., 2008).
Eleven interviewees claimed that economic empowerment is the main precursor to a successful 
reintegration. In line with previous research (e.g., Jobe, 2010; Ray, 2006), most professionals stated that 
escaping miserable economic conditions was the primary reason for re-trafficking: “Accommodation 
and employment are crucial. If victims don’t have enough financial resources, if they don’t have a place 
where to sleep, in a short time they will re-fall prey to traffickers” (SW7). As a final remark, while 
previous research suggests that trafficking victims’ economic rehabilitation is associated with psycho-
logical well-being (Macy & Johns, 2011), evidence from the present study shows that victims began to 
6According to this notion, victims should always be pure, innocent, and helpless (see Aronowitz, 2015; Christie, 1986).
JOURNAL OF HUMAN TRAFFICKING 13
suffer psychologically precisely when their financial needs were met: “Post-trauma is revealed when 
economic stability is attained. After survival needs have been addressed, victims start to feel uncom-
fortable with themselves and begin to reflect on what they have lost and on how trafficking has 
transformed their lives” (PSY2).
Challenges to Reintegration II: Legal and Institutional Barriers
Security and Legal Proceedings
As argued by Surtees (2008), victims’ sense of safety is highly related to their reintegration. A recurrent 
theme in the interviews was the risk of reprisals from the victims’ traffickers: “In my opinion, safety 
and security issues are among the main problems during the entire reintegration process. Even when 
the trafficker in imprisoned, threats do not seem to stop” (SW3). Trafficking victims were protected by 
special security forces while living in the organizations’ shelters. Hence, in those cases, threats were 
mainly directed toward professionals or the victim’s family members. The reasons behind the lack of 
measures taken against the traffickers were tied both to the complexity of trafficking cases and to 
Albania’s weak judicial system.
Lawsuits against the trafficker were initiated either in destination countries (and then transferred to 
Albania) or directly in Albania following the victims’ return. According to the interviewees, the former 
case proved to be a lengthier and more challenging process:
The files need to be translated and transferred, communication letters between foreign and local institutions first 
need to go through the Ministry of Justice before reaching Albanian courts . . . given Albania’s lack of institutional 
infrastructure . . . that takes a lot of time (LAW1).
However, even when the case was initiated in Albania, legal proceedings were unnecessarily long:
Every step of the judicial process – from the moment the victim denounces the trafficker to the police, to when the 
case is sent to the prosecutor, and until it reaches the court – can be dragged on for months or years (LAW2).
Some interviewees claimed that in addition to the obstacles involved in investigating trafficking cases, 
legal proceedings were also prolongated because of the Albanian policemen’s and prosecutors’ 
negligence (e.g., LAW1, LAW2, SW3, SW4). Most practitioners stated that delayed trials negatively 
impacted the victims’ reintegration, both from a security and a psychological perspective. 
Psychologically, attaining justice was paramount to the victims from a retributive point of view (see 
Fletcher, 1999): “The trafficker’s conviction is really important to the victims. If the trafficker in 
imprisoned, victims can put their mind at rest: ‘Yes, I was exploited, but the perpetrator is suffering for 
what he did to me’” (LAW2).
Achieving justice was impeded by judicial delays as much as by accelerated criminal procedures. 
Article 334.1 of the Albanian Criminal Procedure Code (2017) states that every defendant has the right to 
request an abbreviated trial, which allows for the case to be resolved under the existing state of evidence. 
In addition, Article 406 stipulates that if a defendant has demanded an abbreviated trial and a conviction 
decision is issued, the court shall reduce the sentence by one third. A concern expressed by both lawyers 
interviewed in this study was the controversial application of these two articles in most trafficking cases:
Let’s assume that the trafficker is sentenced to seven years – one-third is lowered before he enters prison and a couple 
of years are reduced due to good behaviour in prison – he ends up getting out of prison in no time (LAW1).
Another issue raised by three interviewees was the victims’ lack of notification following traffickers’ 
furloughs7, thus not allowing the former to take appropriate protective measures (SW3). Several 
practitioners suggested that the lenient measures taken against the trafficker were also an outcome of 
corruption:
7A prison furlough is the release of prisoners on a temporary license. Prisoners are allowed to leave the prison for a short period of 
time and then return.
14 K. RAMAJ
You know how things work in Albania . . . the trafficker can ‘buy’ the policeman/prosecutor/judge . . . Although 
I don’t have concrete evidence regarding this transaction, corruption can be implied by the low sentence length 
demanded by the prosecutor or the early groundless release of the trafficker (LAW2).
Even though the involvement of Albanian members of the judiciary in corruptive affairs cannot be 
proven, according to the EC Progress Report (2015), corruption in the Albanian justice system is very 
widespread. The report further notes that Albanian judges and prosecutors are not held sufficiently 
accountable for their actions.
Other difficulties experienced by trafficking victims related to the stress of being a witness in 
criminal cases and to compensation claims in civil cases. Most interviewees stated that testifying either 
in court or at the prosecutor’s office was very challenging for the victims:
I have accompanied victims myself and I can say that the process of providing testimonies mirrors their 
trafficking experience. After testifying, they are often tearful, fearful, frustrated, and traumatized. The intensity 
of questioning is just too much for the victims (LAW2).
The victims’ psychological state was further aggravated by confronting their trafficker in the court 
room. Article 361.7 of the Albanian Criminal Procedure Code (2017) provides that witnesses of grave 
crimes can be questioned at a distance using audio-visual equipment. Nevertheless, evidence from the 
interviews indicates that such practice was not employed in trafficking cases, thus putting victims’ 
well-being in jeopardy: “In practice, video-conference rooms don’t work. Victims have often provided 
court testimonies in front of traffickers, while facing numerous threats and insults by them” (SW3). 
The last challenge faced by Albanian returned trafficking victims during judicial proceedings is related 
to the right of compensation for the harm done to them. According to the EC (2004), compensation is 
one of the essential steps for the socio-economic reintegration of trafficking victims. However, most 
interviewees claimed that the enforcement of compensation claims is problematic: “Traffickers usually 
transfer their assets to their friends and relatives. Consequently, the execution of the victim’s 
compensation is rendered impossible” (LAW1).
Assistance and State Social Services
A concern expressed by almost all interviewees working for NGOs was the lack of stability in service 
provision due to limited funding: “The services provided by our NGO depend on donor funding, 
which isn’t always consistent . . . Sometimes we feel guilty for not being able to pay the victims’ rent . . . 
We haven’t abandoned them; we just truly don’t have enough financial capacities” (SW2). Other 
challenges within the organizational context related to staff members. Several interviewees highlighted 
the need for an increase in human resources as well as the lack of psychosocial support for practi-
tioners providing direct services to trafficking victims:
We carry the weight of the victims’ traumatic stories with us all the time and don’t have a place where to vent. 
I want to consult a psychologist, but I can’t afford it and our organisation cannot pay for it (PSY1).
High levels of stress and burnout among NGO staff members are common. Research has demon-
strated that professionals assisting victims are prone to experiencing secondary traumatic stress or 
compassion fatigue (Jenkins & Baird, 2002; Figley, 2013). Beyond ethical reasons, supporting service 
providers is significant since a healthy staff is better equipped to assist victims in attaining a successful 
reintegration (Surtees, 2008).
As far as state social services are concerned, most practitioners were unsatisfied with the support 
provided by the Albanian government to trafficking victims: “NGOs cannot provide endless long-term 
assistance. The Albanian state should play a primary role – organizations should be considered as 
a form of additional support” (SW5). Some practitioners stated that since 2014–2015, the Albanian 
government had taken two positive steps in assisting anti-trafficking NGOs: 1) covering the financial 
expenses of the sheltered trafficking victims’ food, and 2) paying the salaries of NGO staff. 
Nevertheless, as one interviewee notes: “This is not enough . . . this amount only makes up for 30% 
JOURNAL OF HUMAN TRAFFICKING 15
of the expenses of our organization” (SW4). Additionally, the Albanian State Social Services provides 
an economic assistance of 3,000 Albanian Lek8 per month to all unemployed trafficking victims 
following their release from the shelter (Ligji, 9355-2016). All professionals considered this amount 
insufficient for living a dignified life.
Another service not addressed by the Albanian government is related to medical costs. Similar to 
every Albanian citizen, trafficking victims had the right to be issued a health card, which covers the 
expenses of basic medical services, such as blood tests or doctors’ visits. As previously stated, victims 
suffered from a host of health complications following their trafficking experience, most of which 
required medical treatment. Nevertheless, five interviewees suggested that the costs of such medication 
were not covered by the health card: “The Albanian government needs to invest on drug funds, 
particularly for vulnerable individuals such as trafficking victims. Medicaments are expensive, while 
victims’ salaries are quite low . . . this situation causes discontent among victims” (MD). In addition to 
a lack of medications, trafficking victims were also faced with scarce psychological assistance after 
leaving the shelter. Even though most organizations continued the provision of counseling services 
after victims had been reintegrated in the community, such services were not offered by the Albanian 
state. Psychotherapy sessions following the victims’ exit from the shelter were infrequent. For example, 
one interviewee claimed that the staff of her organization would meet with the victims once in every six 
months after they started to live independently (SW5).
Bureaucracy and Collaboration with State Agencies
Albania’s laws look aesthetically pleasing written down, but the truth is that the system doesn’t work. You are 
constantly referred from one institution to the other and no one seems to be responsible about anything. Now 
think about trafficking victims being faced with this weak bureaucratic system. Victims get intimidated by 
assertive bureaucrats questioning their applications and are reluctant to ask for clarifications. Endlessly chasing 
that minimal assistance that rightfully belongs to them kills their motivation, their will to move forward . . . it’s 
very sad (PSY2).
The post-communist transition has been characterized by low levels of capacity and functionality for 
the Albanian state (Cepiku & Mititelu, 2010). Governing institutions suffer from a lack of efficiency 
and responsibility as well as a “chronic inability to provide even the most basic public goods and 
services” (Ruli, 2003, p. 151). Economic stability was the first aspect of trafficking victims’ reintegra-
tion negatively impacted by Albania’s poor bureaucratic performance. The interviews revealed that 
unemployed trafficking victims had the right to register as job seekers at the Albanian National 
Employment Service, a government agency responsible for assisting Albanian citizens seeking employ-
ment. Nevertheless, 10 professionals claimed that accessing such service was a time-consuming and 
demotivating process for trafficking victims: “Victims need to wait three months until their documents 
are processed and then normally another five months until they find a job. This gap causes financial 
instability, destroys their spirit, and makes them depressed” (SW1).
According to the law on social housing (Ligji nr, 22-2018), Albanian trafficking victims are among 
the prioritized categories of vulnerable individuals in the application for government rent subsidy 
following their stay in a shelter. However, more than half of the practitioners argued that applying for 
affordable housing schemes was a tedious process, requiring numerous documents that victims were 
unable to secure due to their vulnerability and to matters that went beyond their control: “One of the 
required documents is a notarized rental contract. However, most landlords don’t provide this 
contract . . . the real estate system in Albania tends to be informal” (SW3). The difficulties experienced 
by trafficking victims in gaining social housing endured even after submitting the application: “The 
waiting list is too long. Victims have to wait for years, without any guarantee that their application will 
83,000 Albanian Lek is equal to approximately 28 USD.
16 K. RAMAJ
be successful. It largely depends on the will of the Mayor” (SW7). Institutional barriers were also 
evident in the collaboration of anti-trafficking organizations with state agencies:
We face challenges in sending requests and receiving responses from public institutions. Public officials should 
normally respond within ten working days, but that is not always the case. A delayed response also precludes us 
from giving the right legal assistance (LAW1).
The hurdles imposed upon trafficking victims by the Albanian state not only hindered the reintegra-
tion process, but they also increased the probability of victims being re-trafficked: “Various problems 
exist on a systemic and structural level. If victims don’t receive the required support from the state 
after leaving our shelter, they can regress and return to the same vulnerable position before trafficking” 
(SW1). Reflecting on the scarcity of state social services and nonfunctional bureaucracies under the 
theoretical umbrella of critical victimology, the Albanian state can be perceived as a harmful agent in 
the victims’ reintegration process (see Spencer & Walklate, 2016). Data from the interviews imply that 
the weakness of the Albanian state and its failure in providing adequate reintegration assistance had 
a conducive role “in the continued production of victims” (Mawby & Walklate, 1994, p. 14). 
Consequently, the Albanian state can be considered directly responsible for the victims’ re- 
victimization and re-trafficking experiences following their release from organizations’ shelter.
Conclusions
This article examined the individual and structural challenges of Albanian returned victims of sex 
trafficking and forced begging. Contrary to the linear trajectory, which portrays the origin country as 
a safe place (Segrave et al., 2009), returning to Albania was an undesirable outcome for most victims. 
Findings from the current study suggest that victims undergo two main phases following their return: 
rehabilitation and reintegration. The rehabilitation phase is aimed at strengthening the victims’ psycho- 
emotional state within a shelter, while the reintegration process refers to the victims’ independent life 
within the community. The time that victims should spend in a shelter is subject to debate. On the one 
hand, interviewees argued that recovering from trauma is a lengthy process. On the other hand, they agreed 
that being subject to continuous protection created institutional dependency and negatively impacted their 
capacity for self-sufficiency.
Both victims trafficked for sexual purposes and forced begging faced similar challenges following their 
return to Albania. They were reluctant to accept that they had been exploited, suffered from a host of 
health complications, and lacked the motivation to start over. On an economic and institutional level, 
their reintegration was impeded by a lack of financial stability, exploitative working conditions, difficul-
ties in accessing justice, a lack of state social services, and a weak bureaucratic system. Social stigma and 
family rejection were however more prominent challenges among sex trafficking victims. Contrastingly, 
victims trafficked for forced begging were accepted by their families. Nevertheless, reuniting with the 
family was not a healthy solution for these victims due to parental neglect and the involvement of family 
members in the trafficking ring. Hence, the role of families during the reintegration process is polemic. 
On the one hand, family support was considered a crucial precursor to a successful reintegration. On the 
other hand, in cases where family members were involved in the trafficking process or where the familial 
environment was unhealthy, reuniting with the family was not a vital option.
Limitations
This study was an initial attempt to uncover some of the unresearched challenges experienced by Albanian 
trafficking victims during their return, rehabilitation, and reintegration in Albania. Due to time and resource 
constraints, the scope of this research did not allow for a detailed exploration of all victims’ challenges. 
Future studies should attempt to reach returned Albanian trafficking victims directly and to increase the 
scope of the target population by including victims trafficked for forced labor and forced criminality.
JOURNAL OF HUMAN TRAFFICKING 17
Acknowledgments
I am grateful to my MPhil Supervisor, Dr. Paolo Campana, for his guidance and encouragement throughout all the 
stages of the research process. I would also like to extend my thanks to all the four entities that agreed to participate in 
my study: NGO Different and Equal (Alb: Të Ndryshëm dhe të Barabartë), NGO Vatra Psycho-Social Center (Alb: 
Qendra Psiko-Sociale Vatra), NGO Another Vision (Alb: Tjetër Vizion), and the National Reception Centre for 
Trafficking Victims (Alb: Qendra Kombëtare Pritëse e Viktimave të Trafikimit). This research would not have been 
possible without your collaboration. In addition, I am thankful to the three anonymous reviewers for their constructive 
feedback, as well as to the editor for her support and encouragement.
ORCID
Klea Ramaj http://orcid.org/0000-0003-3998-5532
Data Availability Statement
The data that support the findings of this study are in the form of Albanian transcripts and reside with the corresponding 
author, Klea Ramaj. The data are not publicly available since they contain information that could compromise the 
privacy of research participants.
References
Adam, B. D. (1978). Inferiorization and self-esteem. Social Psychology, 41(1), 47–53. https://doi.org/10.2307/3033596 
Adams, C. (2011). Re-trafficked victims: How a human rights approach can stop the cycle of re-victimization of sex 
trafficking victims. George Washington International Law Review, 43(1), 201–234. https://heinonline.org/HOL/P?h= 
hein.journals/gwilr43&i=203 
Agustín, L. M. (2005). Migrants in the mistress’s house: Other voices in the “trafficking” debate. Social Politics: 
International Studies in Gender, State and Society, 12(1), 96–117. https://doi.org/10.1093/sp/jxi003 
Albanian Criminal Code (2017). https://www.legislationline.org/documents/section/criminal-codes/country/47/ 
Albania/show 
Albanian Criminal Procedure Code (2017). https://www.legislationline.org/documents/section/criminal-codes/country/ 
47/Albania/show 
Amnesty International. (2006). Albania – Violence against women in the family: It’s not her shame.
Antkowiak, T. M. (2011). An emerging mandate for international courts: Victim-centered remedies and restorative 
justice. Standford Journal of International Law, 47(2), 279. https://heinonline.org/HOL/P?h=hein.journals/sta 
nit47&i=285 
Aronowitz, A. (2015). Victims of human trafficking: A complex issue. International Studies Center.
Aronowitz, A. (2009). Human trafficking, human misery: The global trade in human beings. Greenwood Publishing 
Group.
Arsovska, J. (2006a). Understanding a ‘culture of violence and crime’: The Kanun of Lek Dukagjini and the rise of the 
Albanian sexual-slavery rackets. European Journal of Crime, Criminal Law and Criminal Justice, 14(2), 161–184. 
https://doi.org/10.1163/157181706777978757 
Arsovska, J. (2015). Decoding Albanian organized crime: Culture, politics, and globalization. University of California 
Press.
Arsovska, J., & Craig, M. (2006b). Honourable behaviour and the conceptualisation of violence in ethnic-based 
organised crime groups: An examination of the Albanian Kanun and the Code of the Chinese Triads. Global 
Crime, 7(2), 214–246. https://doi.org/10.1080/17440570601014479 
Bachman, R., & Schutt, R. K. (2017). The practice of research in criminology and criminal justice. Sage.
Baker, S. E., & Edwards, R. (2012). How many qualitative interviews is enough. [Working Paper]. NCRM. http://eprints. 
ncrm.ac.uk/2273/ 
Bearup, L. S. (2016). Reintegration as an emerging vision of justice for victims of human trafficking. International 
Migration, 54(4), 164–176. https://doi.org/10.1111/imig.12248 
Bogner, A., Littig, B., & Menz, W. (2009). Introduction: Expert interviews—An introduction to a new methodological 
debate. In A. Bogner, B. Littig, & W. Menz (Eds.), Interviewing experts (pp. 1–13). Palgrave Macmillan UK. https:// 
doi.org/10.1057/9780230244276_1 
Boyatzis, R. E. (1998). Transforming qualitative information: Thematic analysis and code development. Sage.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. 
https://doi.org/10.1191/1478088706qp063oa 
18 K. RAMAJ
Brennan, D. (2005). Methodological challenges in research with trafficked persons: Tales from the field. International 
Migration, 43(1–2), 35–54. https://doi.org/10.1111/j.0020-7985.2005.00311.x 
Brunovskis, A., & Surtees, R. (2013). Coming home: Challenges in family reintegration for trafficked women. Qualitative 
Social Work: Research and Practice, 12(4), 454–472. https://doi.org/10.1177/1473325011435257 
Butcher, K. (2003). Confusion between prostitution and sex trafficking. The Lancet, 361(9373), 1983. https://doi.org/10. 
1016/S0140-6736(03)13596-9 
Cepiku, D., & Mititelu, C. (2010). Public administration reforms in transition countries: Albania and Romania between 
the Webberian model and the new public management. Transylvanian Review of Administrative Sciences, 6(30), 
55–78.
Christie, N. (1986). The ideal victim. In E. A. Fattah (Ed.), From crime policy to victim policy (pp. 17–30). St. Martin 
Press.
Clawson, H. J., & Dutch, N. (2008). Identifying victims of human trafficking: Inherent challenges and promising 
strategies from the field. US Department of Health and Human Services (HHS). Washington D.C.
Cwikel, J., & Hoban, E. (2005). Contentious issues in research on trafficked women working in the sex industry: Study 
design, ethics, and methodology. Journal of Sex Research, 42(4), 306–316. https://doi.org/10.1080/ 
00224490509552286 
Danermark, B., Soydan, H., Pashko, G., & Vejsiu, Y. (1989). Women, Marriage and Family – Traditionalism vs. 
Modernity in Albania. International Journal of Sociology of the Family, 19(2), 19–41. http://www.jstor.org/stable/ 
23028475 
De Soto, H., Beddies, S., & Gedeshi, I. (2005). Roma and Egyptians in Albania: From social exclusion to social inclusion. 
The World Bank.
Delap, E. (2009). Begging for change. Research findings and recommendations on forced child begging in Albania/ Greece, 
India and Senegal. Anti Slavery International.
Derks, A. (1998). Reintegration of victims of trafficking in Cambodia. International Organization for Migration.
European Commission. (2004, December 22). Report of the experts group on trafficking in human beings.
European Commission. (2015). Albania. Progress Report.
Europol. (2016). Situation report. Trafficking in human beings in the EU.
Eurostat. (2015). Trafficking in human beings: European Union. Publications of the European Union.
Fattah, E. A. (2016). Towards a critical victimology. Springer.
Figley, C. R. (2013). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the 
traumatized. London, UK: Routledge.
Fletcher, G. P. (1999). The place of victims in the theory of retribution. Buffalo Criminal Law Review, 3(1), 51–63. https:// 
doi.org/10.1525/nclr.1999.3.1.51 
Friesendorf, C. (2009). Strategies against human trafficking: The role of the security sector. Study Group Information.
Frost, D. M. (2011). Social stigma and its consequences for the socially stigmatized. Social and Personality Psychology 
Compass, 5(11), 824–839. https://doi.org/10.1111/j.1751-9004.2011.00394.x 
Gallagher, A. T. (2010). The international law of human trafficking. Cambridge University Press.
Gjermeni, E., Taga, I., Tahsini, I., & Meshi, M. (2008a). Doracak I ofruesve të shërbimeve për mbrojtjen e viktimave të 
trafikimit. Qendra e Aleancës Gjinore për Zhvillim, Tiranë, Shqipëri: OSBE. [Service provider handbook for the 
protection of victims of trafficking. Gender Alliance for Development Centre. Tirana, Albania: OSCE].
Gjermeni, E., Van Hook, M. P., Gjipali, S., Xhillari, L., Lungu, F., & Hazizi, A. (2008b). Trafficking of children in Albania: 
Patterns of recruitment and reintegration. Child Abuse & Neglect, 32(10), 941–948. https://doi.org/10.1016/j.chiabu. 
2007.09.015 
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Prentice & Hall.
Goldenberg, S. M. (2015). Trafficking, migration, and health: Complexities and future directions. The Lancet Global 
Health, 3(3), e118–e119. https://doi.org/10.1016/S2214-109X(15)70082-3 
Gonzalez, W. M. (2002). Human trafficking: Criminalization of victims in the sex industry. Buffalo Wome’s Law Journal, 
11, 19–26. https://heinonline.org/HOL/Page?handle=hein.journals/bufwlj11&id=23&div=&collection= 
Goodey, J. (2003). Migration, crime and victimhood: Responses to sex trafficking in the EU. Punishment & Society, 5(4), 
415–431. https://doi.org/10.1177/14624745030054003 
Goodey, J. (2004a). Sex trafficking in women from Central and East European countries: Promoting a ‘victim-centred’ 
and ‘woman-centred’ approach to criminal justice intervention. Feminist Review, 76(1), 26–45. https://doi.org/10. 
1057/palgrave.fr.9400141 
Goodey, J. (2004b). Victims and victimology: Research, policy and practice. Longman.
Goodey, J. (2008). Human trafficking: Sketchy data and policy responses. Criminology & Criminal Justice, 8(4), 421–442. 
https://doi.org/10.1177/1748895808096471 
Grbich, C. (1998). Qualitative research in health: An introduction. Sage.
GRETA. (2016). Report concerning the implementation of the Council of Europe Convention on Action Against Trafficking 
in Human Beings by Albania. Second evaluation round. Council of Europe.
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 
271–299. https://doi.org/10.1037/1089-2680.2.3.271 
JOURNAL OF HUMAN TRAFFICKING 19
Hales, L., & Gelsthorpe, L. (2012). The criminalizationn of migrant women. Institute of Criminology.
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral 
disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical 
Psychology, 64(6), 1152–1168. https://doi.org/10.1037/0022-006X.64.6.1152 
Herek, G. M. (2009). Sexual prejudice. In T. D. Nelson (Ed.), Handbook of prejudice, stereotyping, and discrimination 
(pp. 441–467). Psychology Press.
Hodge, D. R., & Lietz, C. A. (2007). The international sexual trafficking of women and children: A review of the 
literature. Affilia, 22(2), 163–174. https://doi.org/10.1177/0886109907299055 
Home Office. (2018, June). Country policy and information note. Albania: People trafficking. Independent Advisory 
Group on Country Information.
Human Trafficking Foundation. (2018) . The slavery and trafficking survivor care standards. Langford Printers.
Hysi, V. (2007). Human trafficking and democratic transition in Albania. In H. R. Friman & S. Reich (Eds.), Human 
trafficking, human security, and the Balkans (pp. 96–118). University of Pittsburgh Press.
International Labor Organization. (2017). Global estimates of modern slavery. International Labour Organization and 
Walk Free Foundation.
International Organization for Migration. (2007). Handbook on direct assistance for victims of trafficking. International 
Organisation for Migration.
International Organization for Migration. (2012). Assisted voluntary return and reintegration. Annual report of activities 
2011. International Organisation for Migration.
International Organization for Migration. (2015, January). United Nations Programme “Support to Social Inclusion in 
Albania”. Profile of the situation of trafficking victims and efforts for social inclusions. International Organisation for 
Migration.
Jenkins, S. R., & Baird, S. (2002). Secondary traumatic stress and vicarious trauma: A validational study. Journal of 
Traumatic Stress: Official Publication of the International Society for Traumatic Stress Studies, 15(5), 423–432. https:// 
doi.org/10.1023/A:1020193526843 
Jobe, A. (2010). The causes and consequences of re-trafficking: Evidence from the IOM Human Trafficking Database. 
International Organisation for Migration.
Kiss, L., Pocock, N. S., Naisanguansri, V., Suos, S., Dickson, B., Thuy, D., Koehler, J., Sirisup, K., Pongrungsee, N., 
Nguyen, V. A., Borland, R., Dhavan, P., & Zimmerman, C. (2015). Health of men, women, and children in 
post-trafficking services in Cambodia, Thailand, and Vietnam: An observational cross-sectional study. The Lancet 
Global Health, 3(3), 154–161. https://doi.org/10.1016/S2214-109X(15)70016-1 
Kleemans, E. R., & Smit, M. (2014). Human smuggling, human trafficking, and exploitation in the sex industry. In 
L. Paoli (Ed.), The Oxford handbook of organized crime (pp. 381–401). Oxford University Press.
Le, P. D. (2017). “Reconstructing a sense of self”: Trauma and coping among returned women survivors of human 
trafficking in Vietnam. Qualitative Health Research, 27(4), 509–519. https://doi.org/10.1177/1049732316646157 
Leman, J., & Janssens, S. (2006). An analysis of some highly-structured networks of human smuggling and trafficking 
from Albania and Bulgaria to Belgium. Migracijske I Etničke Teme, 22(3), 231–245. https://www.ceeol.com/search/ 
article-detail?id=126131 
Ligji 9355-2016. Për ndihmën dhe shërbimet shoqërore. [Law 9355/2016. On assistance and social services].
Ligji nr. 22-2018 Për strehimin social. [Law nr. 22/2018. On social housing].
Lisborg, A., & Plambech, S. (2009). Going back-moving on: A synthesis report on the trends and experiences of returned 
trafficking victims in Thailand and the Philippines. International Labour Organisation.
Lyneham, S. (2014). Recovery, return and reintegration of Indonesian victims of human trafficking. Trends and Issues in 
Crime and Criminal Justice, 1(483), 1-8. https://search-informit-org.ezp.lib.cam.ac.uk/doi/abs/10.3316/ielapa. 
566116749372498 .
Macy, R. J., & Johns, N. (2011). Aftercare services for international sex trafficking survivors: Informing U.S. service and 
program development in an emerging practice area. Trauma Violence Abuse, 12(2), 87–98. https://doi.org/10.1177/ 
1524838010390709 
Malloch, M. (2016). Criminalising victims of human trafficking: State responses and punitive practices. In M. Malloch & 
P. Rigby (Eds.), Human trafficking. The complexities of exploitation (pp. 175–194). Edinburgh University Press.
Mawby, R., & Walklate, S. (1994). Critical victimology. Sage.
Maxfield, M. G., & Babbie, E. (2018). Research methods for criminal justice and criminology. Wadsworth.
McCarthy, L. A. (2018). Life after Trafficking in Azerbaijan: Reintegration experiences of survivors. Anti-trafficking 
Review, (10), 105–122. doi:10.14197/atr.201218107
Merton, R. K. (1972). Insiders and outsiders: A chapter in the sociology of knowledge. American Journal of Sociology, 78 
(1), 9–47. https://doi.org/10.1086/225294 
Meshi, M., Picari, B., & Pinderi, R. (2009). Study of the socio-economic reintegration of trafficking victims in Albania. 
Different and Equal. Media Print.
Ministria e Brendshme. (2016a, Shkurt). Strategjia e luftës kundër trafikimit të personave dhe plani i veprimit 2014-2017. 
Pegi. [Ministry of the Interior (2016, February). The strategy for fighting trafficking in persons and the action plan 
2014-2017. Tirana, Albania: Pegi].
20 K. RAMAJ
Ministria e Brendshme. (2016b, Shkurt). Plan veprimi per ri/integrimin socio-ekonomik të grave dhe vajzave viktima të 
trafikimit të personave. Pegi. [Ministry of the Interior (2016, February). Action plan for the socio-economic reintegra-
tion of girls and women, victims of human trafficking. Tirana, Albania: Pegi].
Moffitt, T. E. (2013). Childhood exposure to violence and lifelong health: Clinical intervention science and stress-biology 
research join forces. Development and Psychopathology, 25(2), 1619–1634. https://doi.org/10.1017/ 
S0954579413000801 
Nixon, N. (2009). ‘You can’t eat shame with bread’: Gender and collective shame in Albanian society. Southeast 
European and Black Sea Studies, 9(1–2), 105–121. https://doi.org/10.1080/14683850902723447 
Organization for Security and Co-operation in Europe. (2003) . ODIHR CPRSI Assessment trip to Albania on trafficking 
in children from Roma and Egyptian communities. OSCE Office for Democratic Institutions and Human Rights.
Organization for Security and Co-operation in Europe. (2014). Guiding principles on human rights in the return of 
trafficked persons. OSCE/ODIHR.
Office of the High Commissioner for Human Rights. (2002). Recommended principles and guidelines on human rights 
and human trafficking. United Nations Publications.
Oram, S., Stöckl, H., Busza, J., Howard, L. M., & Zimmerman, C. (2012). Prevalence and risk of violence and the physical, 
mental, and sexual health problems associated with human trafficking: Systematic review. PLoS Med, 9(5), e1001224. 
https://doi.org/10.1371/journal.pmed.1001224 
Paasche, E., Skilbrei, M. L., & Plambech, S. (2018). Vulnerable here or there? Examining the vulnerability of victims of 
human trafficking before and after return. Anti-Trafficking Review, (10), 34–51. doi:10.14197/atr.201218103
Pandey, S., Tewari, H. R., & Bhowmick, P. K. (2013). Antecedents and reintegration of sex trafficked victims in India: 
A conceptual framework. International Journal of Criminal Justice Sciences, 8(1), 47–62. /paper/Antecedents-and- 
Reintegration-of-Sex-Trafficked-in-Pandey-Tewari/f4989cf9a2565181ace1101779cb559bc5cefc8f
Prina, F. (2003). Trafficking of Nigerian girls to Italy. Trade and exploitation of minors and young Nigerian women for 
prostitution in Italy. University of Turin.
Rapley, T. (2011). Some pragmatics of data analysis. In D. Silverman (Ed.), Qualitative research (pp. 273–290). Sage.
Ray, N. (2006). Looking at trafficking through a new lens. Cardozo Journal of Law & Gender, 12, 909–927. https:// 
heinonline.org/HOL/Page?handle=hein.journals/cardw12&id=919&div=&collection= 
Reimer, J. K., Langeler, E., Sophea, S., & Montha, S. (2007). The road home: Toward a model of ‘reintegration’ and 
considerations for alternative care for children trafficked for sexual exploitation. Hagar & World Vision.
Richard, A. O. N. (1999). International trafficking in women to the United States: A contemporary manifestation of slavery 
and organized crime. Center for the Study of Intelligence.
Ruhi, R. A. (2003). Human trafficking in Bangladesh: An overview. Asian Affairs, 25(4), 45–56.
Ruli, G. (2003). Albania: The weakness of the state. In W. P. Van Meurs (Ed.), Prospects and risks beyond EU 
enlargement. South-Eastern Europe: Weak states and strong international support (pp. 151–162). Leske Budrich.
Schloenhardt, A., & Loong, M. (2011). Return and reintegration of human trafficking victims from Australia. 
International Journal of Refugee Law, 23(2), 143–173. https://doi.org/10.1093/ijrl/eer003 
Segrave, M. (2009). Order at the border: The repatriation of victims of trafficking. Women’s Studies International Forum, 
32(4), 251–260. https://doi.org/10.1016/j.wsif.2009.05.006 
Segrave, M., Milivojevic, S., & Pickering, S. (2009). Sex trafficking: International context and response. Willan Publishing.
Sharma, N. (2003). Travel agency: A critique of anti-trafficking campaigns. Refuge: Canada’s Journal on Refugees, 21(3), 
53–65. https://doi.org/10.25071/1920-7336.21302 
Siegel, D., & De Wildt, R. (2015). Ethical concerns in research on human trafficking. Springer.
Simeunovic-Patic, B. (2005). Protection, assistance, and support of trafficked persons: Current responses. In L. Bjerkan 
(Ed.), A life of one’s own: Rehabilitation of victims of trafficking for sexual exploitation.  pp. 23–70. Fafo Institute.
Spencer, D. (2011). Event and victimization. Criminal Law and Philosophy, 5(1), 39–52. https://doi.org/10.1007/s11572- 
010-9108-3 
Spencer, D. C., & Walklate, S. (2016). Reconceptualizing critical victimology: Interventions and possibilities. Lexington 
Books.
Surtees, R. (2006). Reintegration programmes in SE Europe. A background paper for the King Baudouin Foundation. KBF 
& Nexus Institute.
Surtees, R. (2007). Listening to victims: Experiences of identification, return, and assistance in South-Eastern Europe. 
International Centre for Migration Policy Development.
Surtees, R. (2008). Re/integration of trafficked persons: How can our work be more effective. Nexus Institute.
Surtees, R. (2010). Monitoring anti-trafficking re/integration programmes: A manual. Nexus Institute.
Surtees, R. (2017). Supporting the Reintegration of Trafficked Persons: A guidebook for the Greater Mekong Sub-region. 
Nexus Institute.
Surtees, R., Johnson, L. S., Zulbahary, T., & Caya, S. D. (2016). Going home. Challenges in the reintegration of trafficking 
victims in Indonesia. Nexus Institute.
Till-tentschert, U. (2017). The relation between violence experienced in childhood and women’s exposure to violence in 
later life: Evidence from Europe. Journal of Interpersonal Violence, 32(12), 1874–1894. https://doi.org/10.1177/ 
0886260517698952 
JOURNAL OF HUMAN TRAFFICKING 21
Troshynski, E. (2011). Human trafficking. In W. S. DeKeseredy & M. Dragiewicz (Eds.), Routledge handbook of critical 
criminology (pp. 341–359). Routledge.
United Nations (2000). Protocol to prevent, suppress and punish trafficking in persons, especially women and children, 
supplementing the United Nations convention against transnational organized crime. https://www.ohchr.org/en/ 
professionalinterest/pages/protocoltraffickinginpersons.aspx 
United Nations Office on Drugs and Crime. (2006). Toolkit to combat trafficking in persons. United Nations Publications.
United Nations Office on Drugs and Crime. (2008). Toolkit to combat trafficking in persons. United Nations Publications.
United Nations Office on Drugs and Crime. (2009). Combating trafficking in persons: A handbook for parliamentarians. 
United Nations Publications.
US Department of State (2018). Trafficking in persons report. https://www.state.gov/documents/organization/282798.pdf 
US Department of State (2020). Trafficking in persons report. https://www.state.gov/wp-content/uploads/2020/06/2020- 
TIP-Report-Complete-062420-FINAL.pdf 
Van Hook, M. P., Gjermeni, E., & Haxhiymeri, E. (2006). Sexual trafficking of women: Tragic proportions and attempted 
solutions in Albania. International Social Work, 49(1), 29–40. https://doi.org/10.1177/0020872806057086 
Van Nes, F., Abma, T., Jonsson, H., & Deeg, D. (2010). Language differences in qualitative research: Is meaning lost in 
translation? European Journal of Ageing, 7(4), 313–316. https://doi.org/10.1007/s10433-010-0168-y 
Vatra (2017). Annual Report. [Unpublished report].
Walklate, S. (2012). Who is the victim of crime? Paying homage to the work of Richard Quinney. Crime, Media, Culture: 
An International Journal, 8(2), 173–184. https://doi.org/10.1177/1741659012444433 
Warren, K. B. (2012). Troubling the victim/trafficker dichotomy in efforts to combat human trafficking: The unintended 
consequences of moralizing labour migration. Indiana Journal of Global Legal Studies, 19(1), 105–120. https://doi. 
org/10.2979/indjglolegstu.19.1.105 
Wenzlaff, R. M., & Wegner, D. M. (2000). Thought suppression. Annual Review of Psychology, 51(1), 59–91. https://doi. 
org/10.1146/annurev.psych.51.1.59 
Williamson, J., & Serna, K. (2018). Reconsidering forced labels: Outcomes of sexual assault survivors versus victims (and 
those who choose neither). Violence Against Women, 24(6), 668–683. https://doi.org/10.1177/1077801217711268 
Wolhuter, L., Olley, N., & Denham, D. (2008). Victimology: Victimisation and victims’ rights. Routledge-Cavendish.
Zimmerman, C. (2007). Documenting the effects of trafficking in women. In C. Beyrer & H. Pizer (Eds.), Public health 
and human rights (pp. 143–176). Johns Hopkins University Press.
22 K. RAMAJ